The Health Secretary, Sajid Javid, set out his vision for the future of the NHS yesterday. The full speech is available, and I have read it. This is my take on what he said.
First, he acknowledged that demand for healthcare is growing. As he noted:
At the start of this century, in 2000, health spending represented 27 percent of day-to-day public service spending. By 2024, it is set to account for 44 percent. This has been an acceleration of the trend in which the composition of the State has shifted towards health and care over the last 70 years.
To contextualise this he said:
I am a small-state conservative.
To this he added:
My vision of the State is one that is small but strong; empowering not constraining. But if the trajectory of the State continues unchecked, I don’t believe it will be compatible with that vision.
In other words, the future will be characterised by health care cuts. That was the underlying message of yesterday.
How will this be achieved? His answer was threefold.
First, he is going to deliver prevention of ill health. This is going to be done via IT:
We’re putting prevention at the heart of the NHS App, making it the front-door for preventive tools and services – like a new digital health check. And we’re going to further develop the apps and websites that give people direct access to the diagnostics and therapies. That’s the future.
Why is he doing this? Because, he says:
There is no small state which isn’t a ‘pre-emptive state’. The NHS is significantly bigger than it would be if we had done a better job at preventing avoidable disease.
So, we are going to stop disease. Apparently, an app, rather than prevention of the sale of the appalling foodstuffs on which so many are dependent or the making available of lifestyles that are healthy by taking people out of poverty, will do this. This is almost on the Tony Blair scale of naive belief in the power of IT.
Second, he is going to require that we take personal responsibility for our health. He said:
In my party conference speech back in October, I talked about how we’ve got to recognise the power of families to make the difference when it comes to healthcare. Whether it’s stopping drug addiction or dealing with depression, there’s no more powerful motivating force than family. And again, there’s no small state without strong families.
So, it's tough if you do not have a family to rely on.
And it's tough if you are a single parent.
What is more, it's tough if you are a child whose parents have to work and there's no one else around to care for you.
You'll just have to suffer it seems. The NHS of the future is being designed for the family that quite simply no longer exists, all of whose members are just sitting around waiting for someone to care for.
And what is more, it is one where we will all have personal care budgets to manage whilst doing this, which will apparently liberate us. Except they won't of course, because these budgets are rationing by any other name.
Third, he's going to use more IT. Well of course he is: every organisation is doing so. But it will not cut his costs by much. And people are not cared for by IT systems.
So what did we really get? A nightmare view of an NHS where:
- patient contact is limited,
- care is provided subject to struct personal budget constraints,
- where care is outsourced to families, whether or not you have one;
- and an app is the answer to all questions.
It takes considerable inability to come up with a package so far removed from need, and which the experience of experiments on all these issues has shown to be so undeliverable in reality. But that is what the Health Secretary is talking about, nonetheless.
If Javid wanted to set up the NHS to fail this is the speech he would have delivered.
And that is why I think he gave it.